title: A case of chordoma invading multiple neuroaxial bones: report of ten years follow up.
abstract: OBJECTIVE
  Chordoma is a rare, slow-growing primary malignant tumor of the axial skeleton, arising from the embryonic cells of primitive notochord. Chordomas may arise at different sites of the vertebral column simultaneously or more probably they may metastasise along the neural axis insidiously. Recurrence despite radical surgery and following adjuvant therapy is possible.
  
  
  METHODS
  A 46-year-old female patient presented weakness and numbness of the lower extremities. She was operated for clivus chordoma five years ago at another institute.
  
  
  RESULTS
  First the patient underwent surgery for resection of the tumor at the cervical region. a second surgery was performed to resect tumor on the foramen magnum and at the C1 level. Histologic examination of the removed vertebra confirmed the diagnosis of chordoma involving the vertebral body. Radiotherapy was administered after the second surgery. Follow-up neurological and radiological examinations revealed no abnormal neurological symptoms 2,5 years after second surgery. There were no distant organ metastases.
  
  
  CONCLUSIONS
  A patient with diagnosed chordoma of the spine must be investigated with MRI of other regions of the neuraxis to exclude second or even third source of chordoma metastases. In metastatic chordoma cases, radical or gross total resection should be performed for each lesion but if complete surgical resections are impossible, preoperative or postoperative radiation therapy should be planned to improve life expectancy.
authors.affiliation: Istanbul Physical Therapy and Rehabilitation Hospital, Department of Neurosurgery, Istanbul, Turkey.
authors.forename: Ahmet Levent
authors.initials: AL
authors.lastname: Aydin
authors.forename: Mehdi
authors.initials: M
authors.lastname: Sasani
authors.forename: Tunc
authors.initials: T
authors.lastname: Oktenoglu
authors.forename: Ihsan
authors.initials: I
authors.lastname: Solaroglu
authors.forename: Ali Fahir
authors.initials: AF
authors.lastname: Ozer
mesh_terms: D001858:Bone Nails; D002574:Cervical Vertebrae / Q000473:pathology / Q000601:surgery; D002817:Chordoma / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009460:Neurologic Examination; D019635:Neurosurgical Procedures; D012086:Reoperation; D013117:Spinal Cord Compression / Q000209:etiology; D013125:Spinal Neoplasms / Q000473:pathology* / Q000601:surgery*